complementary care products for menopause
Since the recent release of a study on hormone replacement therapy (HRT) and its potential for harmful side effects, many women want to know what alternative remedies are available to treat their symptoms of menopause.
Tiffani Schilling, Pharm.D. and master herbalist at the Mayo Clinic, Rochester, Minn., and the Integrative Care Natural Pharmacy, Vadnais Heights, Minn., said that before pharmacists recommend complementary care solutions, they should ask patients why they went on HRT and how long they have been on it. "If they've been on HRT more than five years, they don't need it if they don't have symptomsunless they have other risk factors for heart diseases, stroke, or osteoporosis," she said.
Asked what herbs she would recommend, Schilling cautioned that while ginseng has been widely touted for having phytoestrogen properties, pharmacists should be aware that there are different kinds of ginseng with different effects. American ginseng, or Panax quinquefolius, has some female hormone qualities along with the ability to modulate the immune system. Panax ginseng, or Koren ginseng, has male hormone qualities and elevates blood pressure. Siberian ginseng has no hormone qualities and does not influence blood pressure.
Soy has been praised for treating menopausal symptoms such as hot flashes and high cholesterol, but Schilling advised R.Ph.s not to recommend soy supplements. "Studies have shown that taking soy as a supplement is totally ineffective. You need to add it to your dietthrough tofu, soy milk, or soy cheese," she said.
Pharmacists should acquaint themselves with wild yam extract, a plant estrogen that Schilling believes helps regulate hormones and relieve night sweats and hot flashes.
Schilling touted grapeseed extract for its antioxidant properties, its abili-ty to conserve vitamins C and E in a woman's body, and for lowering blood pressure. Pharmacists should also advise patients on the use of progesterone creams, with their beneficial effect in regulating a woman's cycle during perimenopause, she said.
Pharmacists should not overlook the value of valerian and kava for anxiety and sleeplessness. Schilling cautioned that kava produces more of an intoxicating effect than valerian and may affect a patient's motor skills. She further advised that women should not take either of these supplements if they are taking an antidepressant. Another useful sleeping aid, she said, is melatonin. For water retention, she advised using a clover/burdock/dandelion combination product. She obtains this product from the Eclectic Institute in Oregon.
DHEA and pregnenolone are also on Schilling's list of beneficial products. "These pre-hormones turn into estrogen, testosterone, and progesterone in the body. Ideally, people should have their blood drawn before they are put on these, because they may not need the high doses that are available OTC," she warned.
For combating vaginal dryness, Schilling suggested the use of progesterone creams and natural lubricants, such as K-Y Jelly.
Donna Lee, R.Ph., Natural Alternatives, Greensboro, N.C., touts soy and the herb guggul for controlling cholesterol, and she thinks B vitamins with folic acid are helpful in lowering homocysteine levels. But when it comes to herbal therapies, Lee cautioned, "you have to look at each individual. I never look at simply substituting an herb for a drug. I look at each woman's lifestyle, nutrition, exercise, and relaxation techniques. I then look at the individual risks the woman may have in her personal and family medical history related to cardiovascular health, osteoporosis, and breast cancer. I have not seen anything to convince me there are herbal therapies that can necessarily replace HRT directly."
Ron Toy, R.Ph., Model Pharmacy, Modesto, Calif., does natural hormone compounding for over 100 patients. He suggested that herbs like black cohosh might be helpful in alleviating some menopausal symptoms. But, he maintained, "for some patients, that's not strong enough. They need to go to the natural hormone compounding side, which I call bio-identical hormone replacement therapy. We make capsules that contain the estrogensestriol, estradiol, and estronethat occur in the body. We use the chemical extracted from the Mexican yam and compound it in a ratio of 80% estriol, 10% estradiol, and 10% estrone, although some patients require a modification of that ratio. Then we work with their physician."
What advice should pharmacists give women who are taking HRT and who want to use herbal remedies? Karmay Kwong, Pharm.D., at the Center for Integrative Medicine, Visalia, Calif., offered this view: "Many pharmacists think they can pick one product for a specific symptom. It's not as easy as that. The key to herbal medicine is to look at the patient as a whole and come up with an herbal formula. Each herbal formula is different from one patient to the next, even though the women may have the same menopausal symptoms."
Sandra Levy. What alternative remedies work for menopause?. Drug Topics 2002;18:57.